International journal of cardiology · 2025
The performance of angiography-derived index of microcirculatory resistance for ischemia in angina with non-obstructive coronary artery disease: Validated by wire-based IMR and SPECT-MPI.
СтатьяВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Wang Jingpu, Li Chenguang, Zhang Mingyou, Zhou Jinying, Zhang Qiyu, Guo Weifeng, Pan Congcong, Yu Haojun, Chang Shufu, Lu Hao, Chen Zhangwei, Shi Hongcheng, Zhang Feng, Qian Juying, Ge Junbo
Аннотация
BACKGROUND: Coronary microvascular dysfunction (CMD) accounts for a significant part of angina with non-obstructive coronary artery (ANOCA). Angiography-derived index of microcirculatory resistance (angio-IMR) has been developed for the evaluation of CMD but not yet validated sufficiently in ANOCA.
AIMS: To validate angio-IMR against wire-based IMR and to investigate its diagnostic performance for ischemia in ANOCA patients.
METHODS: This study included two independent cohorts. The angio-IMR and wire-based IMR were measured in 74 patients (74 vessels) in the wire-based IMR validation cohort. The angio-IMR and single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) were successfully completed in 136 patients (408 vessels) in the SPECT-MPI validation cohort. The ischemia was defined as the myocardial perfusion defect on SPECT-MPI and a summed difference score (SDS) ≥ 2.
RESULTS: In the wire-based IMR validation cohort, the angio-IMR ≥ 25 had the high diagnostic efficiency (area under the receiver-operating characteristics curve (AUC): 0.917, 95 %CI: 0.843-0.922; p < 0.001) and classification agreement (CA) (91.9 %) with the referenced wire-based IMR ≥ 25. In the SPECT-MPI validation cohort, more ischemia was observed in the high angio-IMR group (angio-IMR ≥ 25) compared to the low angio-IMR group (angio-IMR < 25) (55.2 % vs 10.4 %, p < 0.001). The angio-IMR ≥ 25 had a moderate diagnostic performance for ischemia (AUC: 0.759, 95 %CI: 0.670-0.849; p < 0.001), and it could improve the ability to discriminate ischemia in ANOAC patients (integrated discrimination improvement (IDI): 0.184; p < 0.001; net reclassification improvement (NRI): 0.217; p < 0.001).
CONCLUSION: The study demonstrates that angio-IMR, validated through both wire-based IMR and SPECT-MPI, presents a promising and convenient diagnostic approach for identifying ischemia in patients with ANOCA.
AIMS: To validate angio-IMR against wire-based IMR and to investigate its diagnostic performance for ischemia in ANOCA patients.
METHODS: This study included two independent cohorts. The angio-IMR and wire-based IMR were measured in 74 patients (74 vessels) in the wire-based IMR validation cohort. The angio-IMR and single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) were successfully completed in 136 patients (408 vessels) in the SPECT-MPI validation cohort. The ischemia was defined as the myocardial perfusion defect on SPECT-MPI and a summed difference score (SDS) ≥ 2.
RESULTS: In the wire-based IMR validation cohort, the angio-IMR ≥ 25 had the high diagnostic efficiency (area under the receiver-operating characteristics curve (AUC): 0.917, 95 %CI: 0.843-0.922; p < 0.001) and classification agreement (CA) (91.9 %) with the referenced wire-based IMR ≥ 25. In the SPECT-MPI validation cohort, more ischemia was observed in the high angio-IMR group (angio-IMR ≥ 25) compared to the low angio-IMR group (angio-IMR < 25) (55.2 % vs 10.4 %, p < 0.001). The angio-IMR ≥ 25 had a moderate diagnostic performance for ischemia (AUC: 0.759, 95 %CI: 0.670-0.849; p < 0.001), and it could improve the ability to discriminate ischemia in ANOAC patients (integrated discrimination improvement (IDI): 0.184; p < 0.001; net reclassification improvement (NRI): 0.217; p < 0.001).
CONCLUSION: The study demonstrates that angio-IMR, validated through both wire-based IMR and SPECT-MPI, presents a promising and convenient diagnostic approach for identifying ischemia in patients with ANOCA.